About 10%–20% of esophageal foreign bodies require intervention [1]. Dentures are particularly difficult to remove due to their size, sharp edges, and
metal parts [2]. While endoscopy is often effective, some cases need surgery [3]. We report two cases of successful laser-assisted removal of impacted foreign bodies.
Case 1. A 35-year-old man with alcohol use disorder accidentally swallowed his denture.
After failed removal attempts elsewhere, he was referred to our center. Computed tomography
(CT) showed a radiopaque object at the D3 level ([Fig. 1]). Endoscopy confirmed an impacted three-tooth denture with a sharp metallic edge,
deeply embedded in the esophageal wall, with a contained perforation. Given the failure
of conventional techniques, the patient was intubated and endoscopy-guided laser lithotripsy
was used for fragmentation.
Fig. 1 Computed tomography images. a–c A well-defined curvilinear radiopaque density measuring 3.2 × 6.2 cm was noted in
the upper thoracic esophagus at the level of the D3 vertebral body with associated
short segment circumferential wall thickening (9 mm).
Laser fiber (LightTrail Reusable 365 µm; Boston Scientific, Galway, Ireland) was preloaded
onto a catheter (One Action Stent Introduction System [OASIS] internal catheter, 6
Fr; Cook Medical, Bloomington, Indiana, USA), compatible with the 2.8-mm channel ([Fig. 2]). The laser source was a 360-nm Lumenis VersaPulse holmium laser (Boston Scientific,
Marlborough, Massachusetts, USA), with settings of 9.6 W, Frequency 8 Hz, Energy 1200
mJ. This allowed precise disintegration. The narrowest section of the denture was
cut ([Fig. 3]), along with the metallic wire and acrylic resin. The entire procedure was completed
in 15 minutes without collateral damage. The fragments were extracted with a snare
([Video 1]). The decubitus ulcer-induced perforation was closed using the loop-and-clip technique.
Fig. 2 Laser fiber (LightTrail Reusable 365 µm; Boston Scientific, Galway, Ireland) was preloaded
onto a catheter (One Action Stent Introduction System [OASIS] internal catheter, 6
Fr, 203 cm; Cook Medical, Bloomington, Indiana, USA).
Fig. 3 Case 1. a Laser-guided fragmentation of the denture. b Sectioning of the metallic wire. c Denture after complete fragmentation. d Retrieved denture fragments after removal.
Laser-assisted endoscopic fragmentation enabled successful removal of impacted esophageal
foreign bodies and facilitated endoscopic closure, offering a safe alternative to
surgery in complex cases.Video 1
Case 2. A 67-year-old patient presented with dysphagia after eating chicken. CT revealed
a foreign body in the upper esophagus. As in the previous case, retrieval failed.
The bone was fragmented using the same laser technique without complications ([Fig. 4]).
Fig. 4 Case 2. a Impacted chicken bone. b, c
Laser-guided fragmentation of the bone in the upper esophagus. d
Retrieved bone fragment after removal.
Post-procedure assessments showed no leakage. Patients received prophylactic antibiotics,
started oral intake the next day, and were discharged after 3 days, without complications.
Laser-assisted fragmentation is a safe and effective alternative for managing complex
esophageal foreign bodies [4]
[5], reducing surgery and enabling endoscopic closure in cases of perforation.
Endoscopy_UCTN_Code_TTT_1AO_2AL
E-Videos is an open access online section of the journal Endoscopy, reporting on interesting cases and new techniques in gastroenterological endoscopy.
All papers include a high-quality video and are published with a Creative Commons
CC-BY license. Endoscopy E-Videos qualify for HINARI discounts and waivers and eligibility is automatically checked during the submission
process. We grant 100% waivers to articles whose corresponding authors are based in
Group A countries and 50% waivers to those who are based in Group B countries as classified
by Research4Life (see: https://www.research4life.org/access/eligibility/).
This section has its own submission website at https://mc.manuscriptcentral.com/e-videos.
